Thursday, November 21, 2013
Greg Friese, MS, NREMT-P
For EMTs and paramedics scanning the ads in this magazine or browsing the banner ads of EMS websites, there’s a dizzying array of options for online continuing education (CE). Choices range from spending a single hour watching a video or reading an article to an ACLS or PHTLS certification with interactive learning activities to a complete instructor-led online refresher to meet relicensure requirements.
Before purchasing a single hour of online CE or even an annual subscription for unlimited courses, it’s important as an individual or an organization to assess the landscape of online CE. At a minimum, understand:
>> Local, regional, state, or national regulatory requirements or limitations for online learning. There are often limits on the amount of “distributed learning”—an activity that isn’t led by an instructor that can be applied to a license refresher.
>> Needs for tracking and reporting training completion. Organizations that need to transfer records to a state training database or compile an hours-of-training-completed report for policymakers should engage an online training vendor with a learning management system robust enough to automate reporting and data transfer.
>> Integration of online CE within a broader training plan that includes hands-on skill practice sessions, competency checks, case reviews and high-fidelity patient simulators. Online CE can complement or prepare EMTs and paramedics for face-to-face training activities.
Since the early days of the Internet, EMTs and paramedics have been able to find and read articles from EMS publications online. Over time, the delivery methods of online CE have diversified with the increasing capabilities of hardware and software to deliver training content. Online CE can be discussed in four general categories:
>> Asynchronous text
>> Asynchronous video
>> Synchronous video
>> Social content
Online CE is still readily available as text on a page. Peer-reviewed articles authored by experts and accredited by the Continuing Education Coordinating Board for EMS (CECBEMS) are a low-cost and low-technology method for completing online CE. Articles are asynchronous text, which means they can be read any time and at any location. Readers consume articles on laptop and desktop computers, mobile phones and e-book readers like the Kindle.
Accessing an article is as simple as browsing a website or clicking on a search result. A text article posted in a learning management system is likely there only to produce a record of when the link was clicked or elapsed time spent on the document page. There isn’t an accurate way to gauge time spent reading, but that may not be a meaningful data point for a training officer anyway.
To award a CE certificate, the article should be accompanied by a quiz with questions relevant to the article’s learning objectives. An EMT or paramedic’s quiz result is only as good as the knowledge retention, comprehension and application questions posed in the test.
A passing score on the quiz might reflect new knowledge received and understood, but it can just as easily confirm a poorly written assessment or the presence of existing knowledge. Therefore, when choosing or assigning articles, ensure the content is relevant, accurate and up-to-date. The unlimited storage capacity of the Internet can serve articles with out-of-date CPR protocols or treatment based on a protocol not approved in your service area. The author’s biography and the works cited in the endnotes or footnotes are two quick assessments when considering the article’s usefulness.
Articles, as well as other online CE content, can suffer from vagueness and generalities. Be prepared for personnel to report the article wasn’t specific to the medications available to them or that there was a discrepancy in the article’s recommended medical dose and their local protocol. Follow an article reading assignment with face-to-face question and answer session, discussion of applicability within the reader’s jurisdiction, and application of article knowledge in high-fidelity patient simulation.
Asynchronous video, which is video that can be watched at any time and from any device with an Internet connection, better harnesses the power of the microprocessor and a high-speed connection. Video delivered in a learning management system allows tracking of the time spent viewing and can allow the viewer to stop and restart where they left off. The “resume” feature also makes asynchronous video an ideal option for on-duty training.
Online video CE programs are eligible for CECBEMS accreditation as a distributed learning activity. However, keep in mind that a group may also view an online video together, much like watching a DVD, with a training officer, and count the time as instructor-led.
Although video CE programs have the same test limitations as an article CE program, they have a distinct advantage in the array of videography techniques and incorporation of interactive content. Video can range from a speaker talking to the camera to a narrated slide presentation to actual or scripted incident footage to a mashup of all types.
“What you see is what you get” software applications allow for the insertion of Flash learning objects and patient-assessment scenarios into asynchronous video programs. The amount of “whiz-bang” that can be added is only limited by the production timeline, project budget and the content creator’s imagination
Before selecting an online CE program, ensure that it will play reliably from both the server side and viewer side. Content playback needs to be able to meet user demand at peak times, like when recertification deadlines near. User playback might also vary based on the size of an individual’s or organization’s broadband connection. Municipal departments that share an Internet connection with other local government units can experience significant data download delays during weekday business hours. In addition, iOS mobile devices don’t play Flash video.
Asynchronous text and video free up the instructor to present a CE program as an article or video once instead of delivering the same program again and again. Since personnel and instructors are not sharing time and space, it’s more difficult to ask a question and receive an answer. Asynchronous online CE programs should have a method for personnel to submit a question and receive a timely response by email or phone. Organizations can also empower a local educator, EMS officer in the company, or lead paramedic on a shift to answer questions from personnel.
Synchronous video, like webinars and Web conferences, solve the question-and-answer problem by having instructors and personnel share time together without having to be in the same place. A recent CentreLearn webinar on SCUBA diving emergencies was presented by an instructor in Wisconsin and attended by paramedics from throughout the United States and Canada and from as far away as Australia.
Synchronous video is especially popular for instructor-led online refresher programs that attract active-duty military personnel stationed overseas and paramedics working in remote oil and mineral exploration sites. Attendees have the distinct advantage of being able to submit questions and receive answers in real time.
Synchronous video CE programs can be plagued by technical glitches that are especially frustrating when hundreds or even thousands of EMTs and paramedics are online awaiting a presentation. Presenters should have several practice opportunities before the live presentation to test their internet connection, ability to share their desktop screen, and launch and close polls. In addition, a moderator should be available to offer real-time technical support to the presenter/speaker as well as members of the audience. The moderator can also monitor and answer participant questions and pose questions to the speaker.
If you participate in an asynchronous video program like a webinar, take responsibility for your learning by knowing how to mute your telephone or computer microphone, close other applications and alerts that might slow your Internet connection or distract you from the content, and discontinue use of other household or office devices that might be consuming bandwidth.
Social content is a catchall for the vast and growing library of online content, such as videos posted on YouTube, presentations posted on SlideShare, articles published on dozens of EMS blogs, and audio podcasts recorded by and for EMS providers. Social content can be published by anyone at any time. Therefore, the “authority” of the speaker might range from a paramedic with an opinion about backboards to an EMS system manager who has reviewed the scientific literature and developed a consensus regional protocol for discontinuing the use of backboards.
The time to view, read or listen to social content is as variable as the content itself. Thus, most social content is better suited as part of a larger training session. For example, begin a training session by watching several how-to YouTube videos for non-visualized airways. Next, discuss your organization’s airway management protocol before rotating personnel through several hands-on practice stations. Finish the training session with individual competency checks that are completed within the context of a difficulty-breathing scenario.
Another advantage of social content is the plentiful availability of options for all audiences. EMS practitioners including rookies, critical care providers, leaders and supervisors, EMT and paramedic students, and EMS educators can find video channels, podcasts and blog posts tailored to their niche of EMS.
Before assigning social content to personnel, a training officer should review the content as well as the author’s or speaker’s credentials. Are the content creator’s expertise and the quality of the content appropriate for the department’s training needs? Avoid content that will require the training officer to remediate or correct mistakes personnel might read or hear in social content.
Finally, always let training objectives drive the training methodology. An objective to review a pain management protocol is easily accomplished by acknowledging receipt and reading of an electronic document. An objective to assess and appropriately treat a pediatric patient with pain secondary to musculoskeletal trauma is better accomplished through case review and simulation.
Opportunities for online CE are continuing to expand. Smartphones and tablets are encouraging educators to develop training content that has increasing interactivity and immediate feedback. Massive Online Open Courses are the newest frontier on the online CE landscape. Keep an open mind about how, when, and where EMT and paramedic continuing education can be delivered and completed. The EMS classroom is no longer bounded by brick-and-mortar walls and the weekday availability of instructors.
We asked five EMS professionals the question, “What is the best and/or easiest way to fit CE into your schedule?” Here’s what they said.
Time is of the essence for most of us in EMS who are working several jobs or serving on committee assignments locally or nationally— not to mention that the most important service is to our family. What one needs to do is focus on what is hot and what is not. Continuing education is to “continue” your education— focus at conferences on the hottest topics that you know nothing about. Going over the same old stuff may not keep ones interest—it’s important to review, but look for something to challenge and stimulate your thinking. When we stop being enthusiastic about learning something new, you will fall behind and become obsolete—as practitioners and as a generation. We must lead with vision; in each professional’s hands rests the future of our profession.
—Chris Nollette, EdD, NREMT-P, LP
Easy: Sign up for a class (not always the best). Best: Be ready to provide the class when I am available. Hence, seldom is CE Best and Easy.
CE is simply a process that is achieved based upon the demands of the system. I pick it up when and where I can. This is often then the BEST (sometimes, the easiest).
At the end of the annual time clock, you take what you can to fill in the time slot provided. Not often easy, seldom the best. But then you need to adjust to meet what is out there.
—Walt Stoy, PhD, EMT-P
At Crozer Chester Medical Center, we looked at our dispatch patterns and found that Sunday mornings are a predictable time of low call volume and light road traffic. This affords our department the opportunity to bring all but our furthest deployed units into headquarters to hold “Sunday School” for EMS continuing education. A departmental training committee picks topics for a two-week period and each platoon will present that topic to their staff. The departmental training captain submits the rosters to the regional EMS office to document attendance for CE credit.
—Fran Hildwine, BS, EMT-P
As a volunteer EMT with a fulltime job, finding time to fit in classes for CEU credits can be a challenge and take some careful planning. I’ve used vacation days to attend conferences such as EMS Today or to take classes only available on weekdays. But that’s not always practical. I’ll find weekend programs that fit into my schedule, while also not upending my family life. I also keep an eye open for local opportunities to take classes with other organizations. And I complete online programs available to EMTs in my region.
Completing ongoing CEU classes is a requirement to keep my certifications current. However, I do believe they are much more than just racking up statistics. These classes are key to keeping my skills and knowledge base fresh, which directly impacts the residents of the community where I serve.
—Richard Huff, EMT-B
There is great continuing education (CE) available via electronic media that is available 24/7. While sitting in the front of an ambulance or in a station, providers can stream lectures on just about anything. Credit granted for CE can vary from state to state and agency to agency but sometimes we can focus on learning something new rather than just “getting the hours.” ACLS, PALS and PHTLS can be completed online with a short session in an educational facility to practice and validate skills. Additionally, short CE sessions are sometimes offered by EMS agencies and hospitals. Providers can stop in for two hours of CE and oftentimes get a donut.
--Dennis Edgerly, EMT-P